The JAK2V617F mutation is found in the majority of myeloproliferative neoplasms (MPNs) including polycythemia vera (PV), essential thrombocythemia and primary myelofibrosis. Similar to chromosome- positive (Ph+) chronic myeloid leukemia (CML), these Philadelphia chromosome-negative (Ph-) MPNs are also derived from hematopoietic stem cells (HSCs) and have a risk of developing thrombosis and acute leukemia. There are still no curative therapies for these Ph- MPNs. Recent discovery of the JAK2V617F mutation has promoted the development of targeted therapy using JAK2 inhibitors to inhibit the function of JAK2V617F. Although some early-stage clinical trials show improvement of symptoms and quality of life in patients, the long-term effectiveness of these JAK2 inhibitors remains to be determined. There are already some concerns for the side effects of these drugs. On the other hand, it has been shown that inhibition of JAK2V617F with a JAK2 inhibitor does not eradicate PV-initiating cells, implying that inhibition of the kinase activity o JAK2V617F with a JAK2 inhibitor is unlikely to cure MPNs, which is a situation similar to the treatment of Ph+ CML with BCR-ABL kinase inhibitors that control but do not cure CML. The development of a curative therapy for MPNs requires in-depth studies of the molecular basis of JAK2V617F in initiation and maintenance of these diseases for identifying new and effective target genes. In this application, we focus on PV, a major form of MPNs associated with JAK2V617F. We have observed that Ph+ CML and Ph- MPNs involve the same HSC cell population and have similar myeloproliferative phenotype, suggesting that the disease-initiating cells for CML and PV might share some common regulatory mechanisms. My laboratory has a history of studying the biology and molecular targeting of CML-initiating cells or leukemia stem cells (LSCs) in CML, and we show that the survival and self-renewal of LSCs require the arachidonate 5- lipoxygenase gene (Alox5) and that Alox5 is essential for CML development (Chen et al. Loss of the Alox5 gene impairs leukemia stem cells and prevents chronic myeloid leukemia. Nature Genetics 41:783-792, 2009). We also show that inhibition of Alox5 function leads to eradication of LSCs and prolonged survival of CML mice. Our preliminary data show that JAK2V617F activates Alox5 and loss of the Alox5 gene impedes the development of JAK2V617F-induced PV in mice, which is supported by prolonged survival of PV mice treated with an Alox5 inhibitor. These preliminary results allow us to hypothesize that Alox5 plays a significant role in the development of PV induced by JAK2V617F and is a potential target gene for the treatment of PV. The specific aims are: 1) To determine signaling pathways involved in Alox5 activation by JAK2V617F; and 2) To test whether inhibition of the Alox5 pathway suppresses mouse and human PV cells. These studies will build a solid foundation for future PV clinical trials by targeting the Alox5 pathway. PUBLIC HEALTH RELEVANCE: The JAK2V617F mutation is found in almost all patients with polycythemia vera (PV) that disrupts bone marrow functions and becomes leukemia. JAK2 inhibitors improve symptoms and quality of life but their long-term effectiveness remains to be determined. JAK2 inhibitors do not eradicate PV-initiating cells, and are unlikely to cure the disease. We have observed that JAK2V617F activates a novel gene called Alox5 and loss of this gene impedes the PV development in mice. Also, an Alox5 inhibitor prolongs survival of PV mice. These preliminary results indicate that Alox5 is a promising target gene for PV treatment. Our studies in this application will build a solid foundation for future PV clinical trials by targting the Alox5 pathway.